Iliotibial Band Syndrome (ITBS) - Part 2

Understanding Motion Patterns

The successful resolution of Iliotibial Tibial Band Syndrome (ITBS) involves a complex understanding of kinetic chain relationships, and a functional understanding of how motion of the knees is related to specific anatomical structures. When you observe a deviation from normal motion patterns it is a direct indication of what structures may be involved in creating and perpetuating ITBS.

The structural problem will be a combination of four functional muscle groups:

• Agonists (Prime mover) – Muscles that contract to produce a specific movement. Example: The quadricep is a prime knee extensor.
• Antagonists – Muscles on the opposite side of the joint of the agonist. Example: Hamstrings are antagonists to the quadriceps.
• Synergist – Muscles which limit motion as the prime movers contract and also assist motion. Example: The Iliopsoas, and tensor fascia lata are synergists to the quadriceps.
• Stabilizers – Muscles which fix or stabilize the bones of the origin of the prime movers.

This, combined with a whole body examination of kinetic chain relationships, provides the practitioner with insight into what it will take to resolve your ITBS.

In the next section I review some specific knee actions and some of the structures involved in those actions. Optimal knee function is about maintaining a balance of these structures in order to achieve stability in the knee with all motions performed. It is important to note that many of these structures are far from the site of pain yet they can have a direct effect on knee function.

Specific Structure that Affect Knee Stability

Muscles involved in knee flexion:

· Semimembranosis, Semitendinosis, Biceps Femoris (hamstrings)

· Tension in biceps femoris can easily cause lateral knee pain.

· Gastrocnemius (Calf muscle)

· Popliteus (small muscle behind knee)

Muscles involved in knee extension:

· Gluteus Maximus

· Quadriceps femoris (all four quadriceps)

· TFL (Tensor fasciae latae)

Muscles involved in internal rotation of the knee:

· Gracilis - This muscle is frequently injured with sudden inward (adduction) movements of the knee.

· Sartorius – The longest muscle in the body. This muscle crosses both the hip and knee joint, and can be a direct connection between hip and knee function.

· Semitendinosis (hamstring)

· The Gracilis, Semitendinosis, and Sartorius all insert into an area called the pes anserinus. This area is at the bottom of the leg (femur) on the inside of the knee. The pes anserinus is a common area in which to develop knee pain.

· Semimembranosis (hamstring)

· Popliteus

Muscles involved in external rotation of the knee:

· Biceps Femoris (Long and short head - hamstring)

· Gluteus Maximus

· TFL (Tensor fasciae latae)

In part three of Resolving ITBS, we will cover hip muscles that effect knee function.

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